Outcomes of patients on dual antiplatelet therapy post-coronary stenting following emergency noncardiac surgery.

BACKGROUND: The outcomes of patients on dual antiplatelet therapy (DAPT) post-coronary stenting following emergency noncardiac surgery remain unclear. METHODS: This retrospective cohort study included patients on DAPT post-coronary stenting who underwent emergency noncardiac surgery within 24 hours of diagnosis from April 2007 to March 2018 where DAPT was discontinued within <5 days for aspirin and 7 days for P2Y12 inhibitors. Our primary outcome was 180-day mortality in these patients. We investigated factors associated with bleeding within 180 days after surgery as our secondary outcome and exploratorily examined factors affecting 180-day mortality. RESULTS: Of 62,528 patients who underwent any surgery under general anaesthesia during the 11-year study period, 133 patients (0.22% of all and 1.41% of emergency surgical patients) were analysed. Among the eligible patients, 180-day mortality was 9.8% (13/133). Eighteen patients (13.5%) developed bleeding within 180 days after surgery, which was the most common post-operative complication. Restarting antiplatelet agents <2 days post-operatively (OR, 4.51; 95% CI, 1.56-13.0; P = 0.005) and stent implantation at bifurcation lesions before surgery (OR, 3.28; 95% CI, 1.07-10.1; P = 0.04) were associated with post-operative bleeding. Patients on haemodialysis had the worse prognosis (hazard ratio, 5.73; 95% CI, 1.87-17.5; P = 0.002) in terms of 180-day mortality. CONCLUSION: The 180-day mortality following emergency noncardiac surgery was approximately 10% in patients on DAPT post-coronary stenting. Restarting antiplatelet agents earlier than 2 days post-operatively and coronary stenting at bifurcation lesions were associated with bleeding within 180 days after surgery.

Prognostic factors in critically ill patients with hematological malignancy admitted to the general intensive care unit: a single-center experience in Japan.

PURPOSE: This study aims to identify prognostic factors related to short-term and long-term outcomes of patients with hematological malignancy (HM) admitted to the intensive care unit (ICU) in Japan during ICU stay and after discharge from ICU. METHODS: We conducted a retrospective, observational study of 169 patients with HM admitted to the general ICU from January 2009 to December 2016. We examined prognostic factors affecting outcome during ICU stay and at 180 days after ICU discharge using logistic regression analysis. RESULTS: During ICU stay, 57 patients (33.7%) died. Invasive mechanical ventilation (OR 8.96, 95% CI 3.67-21.9; P < 0.001, the same hereinafter), the Sequential Organ Failure Assessment (SOFA) score within the first 24 h of ICU admission (1.25, 1.11-1.40; P < 0.001), and malignant lymphoma (0.30, 0.11-0.78; P = 0.014) were detected as factors associated with ICU outcome. Of 112 ICU survivors, 46 (41.1%) died within 180 days after ICU discharge. Duration of ICU stay (1.07, 1.01-1.13; P = 0.027) and the SOFA score at ICU discharge (1.24, 1.04-1.48; P = 0.016) were related to poor outcome at 180 days after ICU discharge. CONCLUSIONS: In critically ill patients with HM, the use of invasive mechanical ventilation, a high SOFA score within the first 24 h of ICU admission, and malignant lymphoma as primary HM affected short-term ICU outcome. Increased duration of ICU stay and SOFA score at ICU discharge influenced long-term outcome at 180 days after ICU discharge.

Oxygen management in mechanically ventilated patients: A multicenter prospective observational study.

PURPOSE: To observe arterial oxygen in relation to fraction of inspired oxygen (FIO2) during mechanical ventilation (MV). MATERIALS AND METHODS: In this multicenter prospective observational study, we included adult patients required MV for >48h during the period from March to May 2015. We obtained FIO2, PaO2 and SaO2 from commencement of MV until the 7th day of MV in the ICU. RESULTS: We included 454 patients from 28 ICUs in this study. The median APACHE II score was 22. Median values of FIO2, PaO2 and SaO2 were 0.40, 96mmHg and 98%. After day two, patients spent most of their time with a FIO2 between 0.3 and 0.49 with median PaO2 of approximately 90mmHg and SaO2 of 97%. PaO2 was ≥100mmHg during 47.2% of the study period and was ≥130mmHg during 18.4% of the study period. FIO2 was more likely decreased when PaO2 was ≥130mmHg or SaO2 was ≥99% with a FIO2 of 0.5 or greater. When FIO2 was <0.5, however, FIO2 was less likely decreased regardless of the value of PaO2 and SaO2. CONCLUSIONS: In our multicenter prospective study, we found that hyperoxemia was common and that hyperoxemia was not corrected.

Efferent innervation of photoreceptors in spiders.

The anterior median (AM) eye of the nocturnal spider Araneus ventricosus showed a marked circadian oscillation of sensitivity, but that of the diurnal spider Menemerus confusus showed no circadian oscillation. The AM eyes of the noct/diurnal spiders Argiope amoena and A. bruennichii have two types of photoreceptor cells with different sensitivities. The more sensitive cells showed a circadian oscillation of sensitivity, but the less sensitive cells did not. The circadian sensitivity change of the eyes was controlled by efferent neurosecretory fibers in the optic nerve. Illuminating the brain increased the frequency of efferent impulses in the optic nerve of Argiope, showing that certain photosensitive neurons are present in the brain. However, it seemed that the cerebral photosensitive neurons may be different from the efferent neurosecretory cells. The response of the cerebral photosensitive neurons increased transiently following diminution of the light intensity striking the eyes. The interaction between the cerebral photosensitive neurons and the eyes seemed to play a role in increasing this response.

[A case of intraoperative hyperkalemia induced with administration of an angiotensin II receptor antagonist (AIIA) and intake of dried persimmons].

An 87-year-old man was scheduled for cervical laminectomy. Anesthesia was maintained with nitrous oxide, oxygen, sevoflurane, and fentanyl with tracheal intubation. Thirty minutes after the start of operation, serum potassium was 7.41 mEq x l(-1). We immediately administered potassium-free fluid, furosemide, bicarbonate, calcium gluconate and insulin. We stopped the operation and returned the patient to supine position, but he fell into ventricular fibrillation. Immediate CPR and countershock successfully restored sinus rhythm within 5 minutes. He was discharged from ICU without any neurological complications. Daily he took Losartan potassium, an AIIA, due to hypertension and ate preoperatively dried persimmons, a potassium-rich food. We suspect that hyperkalemia was induced by administration of an AIIA in combination with excessive intake of dried persimmons. AIIA may cause severe hyperkalemia inhibiting aldosterone activity. We should pay attention to the serum potassium level and a preoperative intake of food especially in a patient medicated with an AIIA.

Successful treatment of fulminant community-acquired Pseudomonas aeruginosa necrotizing pneumonia in a previously healthy young man.

This report presents a case of fulminant community-acquired Pseudomonas aeruginosa necrotizing pneumonia in a previously healthy young man, including an analysis of the virulence of the P.aeruginosa isolated from the patient. The patient was successfully treated with intensive care and antibiotic treatment. This study analyzed the pathogenicity of the isolated strain both in vivo (using a mouse pneumonia model) and in vitro (using biofilm production), but could not explain how an otherwise healthy young man developed such severe community-acquired P.aeruginosa pneumonia. Although rare in community-acquired pneumonia, P.aeruginosa infection should be considered in patients with severe rapidly progressive pneumonia.

Molecular evolution of arthropod color vision deduced from multiple opsin genes of jumping spiders.

Among terrestrial animals, only vertebrates and arthropods possess wavelength-discrimination ability, so-called "color vision". For color vision to exist, multiple opsins which encode visual pigments sensitive to different wavelengths of light are required. While the molecular evolution of opsins in vertebrates has been well investigated, that in arthropods remains to be elucidated. This is mainly due to poor information about the opsin genes of non-insect arthropods. To obtain an overview of the evolution of color vision in Arthropoda, we isolated three kinds of opsins, Rh1, Rh2, and Rh3, from two jumping spider species, Hasarius adansoni and Plexippus paykulli. These spiders belong to Chelicerata, one of the most distant groups from Hexapoda (insects), and have color vision as do insects. Phylogenetic analyses of jumping spider opsins revealed a birth and death process of color vision evolution in the arthropod lineage. Phylogenetic positions of jumping spider opsins revealed that at least three opsins had already existed before the Chelicerata-Pancrustacea split. In addition, sequence comparison between jumping spider Rh3 and the shorter wavelength-sensitive opsins of insects predicted that an opsin of the ancestral arthropod had the lysine residue responsible for UV sensitivity. These results strongly suggest that the ancestral arthropod had at least trichromatic vision with a UV pigment and two visible pigments. Thereafter, in each pancrustacean and chelicerate lineage, the opsin repertoire was reconstructed by gene losses, gene duplications, and function-altering amino acid substitutions, leading to evolution of color vision.